POS1502-HPR A PHYSICAL EXERCISE PROGRAM FOR THE MANAGEMENT OF FATIGUE IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) AT THE TIME OF PANDEMIC: A PILOT STUDY
Authors: E. Elefante, C. Tani, V. Signorini, C. Stagnaro, L. Lunardi, D. Zucchi, F. Trentin, L. Carli, F. Ferro, M. Mosca
Journal: Annals of the Rheumatic Diseases (2022)

Background Fatigue in SLE has a multifactorial origin and disease activity seems to contribute only minimally to its genesis. Therefore, non-pharmacological therapeutic strategies should also be considered in the management of fatigue. There is some evidence on the effectiveness of aerobic exercise programs in improving fatigue, without a negative impact on disease manifestations. Objectives the aim of this study was to analyze fatigue and Health Related Quality of Life (HRQoL) in a monocentric cohort of patients with SLE, in a condition of stable remission or low disease activity, before and after a program of physical exercise, through the administration of validated Patient Reported Outcomes (PROs). Methods this is a cross-sectional interventional study which included patients with SLE, aged between 18 and 55 years, in a condition of stable (≥12 months) remission (DORIS) 1 or low disease activity (LLDAS) 2 . Patients enrolled had a FACIT score ≤40 in the previous 6 months. Patients with other possible causes of fatigue (e.g.: anemia, hypothyroidism, severe vitamin D deficiency), active arthritis or physical disabilities were excluded. For each patient, demographics, comorbidities, treatment, clinical and laboratory data were collected. Disease activity was evaluated with the SELENA-SLEDAI and organ damage with the SLICC/DI. Each patient completed the following PROs before and after the interventional program: SF-36, FACIT-Fatigue, LIT, HADS. Due to the limitations related to the COVID-19 pandemic, the physical exercise sessions were carried out using the Google Meet digital platform. Patients were asked to participate to at least 70% of the lessons. The physical exercise program included moderate intensity aerobic exercises (muscle strengthening, joint mobility, breathing, static and dynamic stretching, balance and neuro-dynamics); workouts were performed 3 times a week, consisting of 60 minutes each. The program lasted for 12 weeks. Results we enrolled 12 female patients, regularly followed at the Rheumatology Unit of Pisa; only 9 of them completed the study (mean age 38.56 ± 9.1 years; median disease duration 7 years (IQR 5,25-9,75)). 8/9 were in stable remission, while 1/9 was in LLDAS for the presence of leukopenia. 2/9 patients presented organ damage, one for cataract and one for renal insufficiency, while none presented damage in the musculoskeletal system. 33.3% of patients had fibromyalgia. 88.8% was on treatment with Hydroxychloroquine, 55.5% was on low dose steroids (2±1.9 mg/daily), 33.3% was on Mycophenolate Mofetil; only 1 patient was on Belimumab. All PROs showed a trend to improvement at the end of the 12-week program of physical activity (Table 1). We demonstrated a statistically significant improvement of: FACIT, LIT, depression score of the HADS and MCS of the SF-36. The items of role physical (RP), vitality (VT) and mental health (MH) of the SF-36 also showed a significant improvement. Table 1. Scores of PROs before and after the physical exercise program. PROs Mean scores at baseline Mean scores after the 12-week exercise program p FACIT 30.2 ± 4.9 39.3 ± 7.2 0.01 PF 73.18 ± 10.9 78.9 ± 10.5 0.18 RP 50 ± 13.2 67.4 ± 18.6 0.03 BP 52 ± 12.1 54.1 ± 11.1 0.73 GH 41.7 ± 11.1 48.4 ± 11.1 0.07 VT 34.7 ± 12.5 59.0 ± 14.2 0.002 SF 58.3 ± 15.6 66.7 ± 16.7 0.3 RE 55.5 ± 21.5 69.4 ± 18.0 0.13 MH 58.3 ± 15.8 67.2 ± 16.2 0.03 PCS 43.8 ± 4.0 46.1 ± 4.8 0.19 MCS 38.6 ± 8.8 45.6 ± 8.7 0.03 LIT 36.9 ± 14.2 27.5 ± 14.1 0.05 HADS (A) 9 ± 4.4 7.7 ± 3.2 0.4 HADS (D) 7.9 ± 4.4 5.1 ± 2.96 0.05 Conclusion In a small cohort of SLE patients in remission but with severe fatigue, in the difficult context of COVID-19 pandemic, we demonstrated that an online program of physical exercise may determine a significant improvement of fatigue, perception of disease burden and mental health. In the context of a multidisciplinary management, finding effective intervention programs to improve fatigue and HRQoL in SLE patients appears of utmost importance, with the final aim of improving patients’ health status. References [1]PMID 27884822; 2 PMID 26458737 Disclosure of Interests None declared